Self-help Application for Obsessive-Compulsive Disorder Based on Exposure and Response Prevention Technique: Prototype Design and Usability Evaluation (Preprint)

BACKGROUND Obsessive-compulsive disorder (OCD) is a relatively common disorder that, due to its debilitating nature, significantly affects personal abilities, job performance, social adjustment, and interpersonal relationships. There are significant barriers to accessing evidence-based cognitive-behavioral therapy as a first-line treatment for obsessive-compulsive disorder. Mobile health applications (Apps) offer a promising way to improve access to evidence-based therapies while overcoming these barriers. OBJECTIVE This study aimed to design and evaluate a prototype of a self¬-help application for people with contamination OCD based on exposure and response prevention (ERP) technique. METHODS This work was developed in four different phases. 1) Needs assessment: Thorough literature review, reviewing existing related programs and apps, and interviewing patients and psychiatrists; 2) Create paper prototype: Considering the functional features identified in the previous phase using wireframe sketcher software. 3)Create digital prototype: developing an actual prototype using Axure RP software based on the information obtained from the evaluation of the paper prototype by expert panel. 4) Prototype usability evaluation: Through a heuristic evaluation with experts and a usability testing with patients using SUS questionnaire. RESULTS After requirement analysis, requirements were defined in the areas of information and educational elements and functional capabilities. Prototypes designed based on identified requirements include capabilities such as in-app online self-help group, assessing the severity of the symptoms of the disorder, psychological training, supportive treatment strategies, setting personalized treatment plan, tracking treatment progress through weekly reports provided, anxiety assessment, setting reminder. The results of heuristic evaluation of 5 experts showed that out of the total identified problems, the most problems are related to the” aesthetic and minimalist design” principle and the least problems are related to ”visibility of system status” and” flexibility and efficiency of use”. No problems were identified for “good error message”. Violated problem in the final application should be resolved and refinement can be made based on the experts' comments and suggestions. In usability testing with 10 patients, mean score of patients’ responses in the SUS questionnaire was 76.75 that indicates that the usability of the app prototype is good from the patient's perspective. CONCLUSIONS The results of heuristic evaluation with experts made it possible to identify how to provide information and to implement the capabilities in a way that can be more appropriate and easier for the user Furthermore, the results of the usability evaluation with potential prototype users showed the that implementing remote treatment with mobile app can be promising to help people with contamination OCD.

Self-help Application for Obsessive-Compulsive Disorder Based on Exposure and Response Prevention Technique: Prototype Design and Usability Evaluation (Preprint)

BACKGROUND Obsessive-compulsive disorder (OCD) is a relatively common disorder that, due to its debilitating nature, significantly affects personal abilities, job performance, social adjustment, and interpersonal relationships. There are significant barriers to accessing evidence-based cognitive-behavioral therapy as a first-line treatment for obsessive-compulsive disorder. Mobile health applications (Apps) offer a promising way to improve access to evidence-based therapies while overcoming these barriers. OBJECTIVE This study aimed to design and evaluate a prototype of a self¬-help application for people with contamination OCD based on exposure and response prevention (ERP) technique. METHODS This work was developed in four different phases. 1) Needs assessment: Thorough literature review, reviewing existing related programs and apps, and interviewing patients and psychiatrists; 2) Create paper prototype: Considering the functional features identified in the previous phase using wireframe sketcher software. 3)Create digital prototype: developing an actual prototype using Axure RP software based on the information obtained from the evaluation of the paper prototype by expert panel. 4) Prototype usability evaluation: Through a heuristic evaluation with experts and a usability testing with patients using SUS questionnaire. RESULTS After requirement analysis, requirements were defined in the areas of information and educational elements and functional capabilities. Prototypes designed based on identified requirements include capabilities such as in-app online self-help group, assessing the severity of the symptoms of the disorder, psychological training, supportive treatment strategies, setting personalized treatment plan, tracking treatment progress through weekly reports provided, anxiety assessment, setting reminder. The results of heuristic evaluation of 5 experts showed that out of the total identified problems, the most problems are related to the” aesthetic and minimalist design” principle and the least problems are related to ”visibility of system status” and” flexibility and efficiency of use”. No problems were identified for “good error message”. Violated problem in the final application should be resolved and refinement can be made based on the experts' comments and suggestions. In usability testing with 10 patients, mean score of patients’ responses in the SUS questionnaire was 76.75 that indicates that the usability of the app prototype is good from the patient's perspective. CONCLUSIONS The results of heuristic evaluation with experts made it possible to identify how to provide information and to implement the capabilities in a way that can be more appropriate and easier for the user Furthermore, the results of the usability evaluation with potential prototype users showed the that implementing remote treatment with mobile app can be promising to help people with contamination OCD.

The Inhibitory Learning Approach to Exposure and Response Prevention for Obsessive-Compulsive Disorder

Exposure and response prevention (ERP) is the most effective treatment for obsessive-compulsive disorder (OCD), with robust symptom gains consistently observed. Yet, both research and clinical practice indicate ERP is not equally efficacious for all individuals with OCD, and a considerable portion fail to achieve full symptom remission or experience relapse despite substantial short-term gains. To this end, inhibitory learning theory (ILT) has emerged as an empirically driven conceptual framework for implementing ERP with the goal of optimizing the efficiency and durability of treatment gains. This chapter reviews the conceptual framework for ERP, illustrates ERP through a case example in which common pitfalls were encountered, defines ILT, and illustrates the use of ILT to address these pitfalls.

1 Neurosurgery for severe OCD: the past, present and future

Obsessive compulsive disorder (OCD) is a common disorder thought to have a prevalence of 1-2%. The majority of patients are helped by treatments such as exposure and response prevention therapy and medication. A significant minority fail to benefit from optimal treatment and are severely disabled with respect to everyday function.Such patients may be candidates for a neurosurgical approach. This talk will trace the development of neurosurgery for severe OCD beginning with leucotomy/lobotomy which was practiced in the early part of the 20th Century and left an unfavourable legacy. Advancements in neurosurgery have allowed techniques such as anterior cingulotomy and anterior capsulotomy to be practiced at present and will be compared. Deep brain stimulation for severe OCD was introduced as an alternative to ablation neurosurgery but the optimal target for electrode placement remains under debate and will be discussed with reference to a study directly comparing DBS of two emerging targets within the same patients. Finally, methods of target refinement will be discussed which may improve patients outcome in the near future.

Treatment Adherence as Predictor of Outcome in Concentrated Exposure Treatment for Obsessive-Compulsive Disorder

Background: The treatment of choice for obsessive-compulsive disorder (OCD) is exposure and response prevention (EX/RP). Previous studies have demonstrated that treatment adherence predicts treatment outcome for patients with OCD, but there is little knowledge on its role in concentrated exposure treatment for OCD.Method: In the present study, 42 patients received EX/RP treatment using the Bergen 4-day format. Adherence was measured with the Exposure and Response Prevention Adherence Scale (PEAS, rated both by patients and therapists) after the second and third day. Treatment outcome (symptoms of OCD, depression, anxiety, work- and social functioning, and well-being) was assessed at 3-month follow-up.Results: At follow-up, 71.4% were in remission. High adherence was reported (mean score of 6 on a 1–7 scale). The combination of patient- and therapist rated adherence was significantly associated with treatment outcome whilst controlling for age, sex, and pre-treatment scores. Patients with higher degree of adherence reported less symptoms, higher functioning, and more well-being at follow-up.Conclusions: The results of the present study indicated that adherence in concentrated exposure treatment is significantly associated with a wide range of treatment outcomes for OCD.